Public Health Research & Practice最新文献

Since 2020, hundreds of thousands of more deaths than expected have been observed across the globe. Amid the coronavirus 2019 (COVID-19) pandemic, current research priorities are to control the spread of infection and minimise loss of life. However, there may be future opportunities to learn from the pandemic to build a better healthcare system that delivers maximum health benefits with minimum harm. So far, much research has focused on foregone benefits of healthcare services such as cancer screening during the pandemic. A more balanced approach is to recognise that all healthcare services have potential harms as well as benefits. In this way, we may be able to use pandemic 'natural experiments' to identify cases where a reduction in a healthcare service has not been harmful to the population and some instances where this may have even been beneficial.

Aim: To improve health outcomes, policy and practice decisions should be guided by relevant and timely evidence. High-quality, large-scale population data could play an essential role in supporting evidence-based decision making. The 45 and Up Study is a long-term, large-scale cohort study with more 250 000 participants aged 45 years and over from New South Wales (NSW), Australia. Data collected by the Study is accessible to researchers, government and non-governmental bodies. The study aimed to identify the proportion of researchers using data from the Study who intended to have an impact and achieved impact; the types of impact they intended and achieved; and the pathways through which they achieved it.

Methods: Using data extracted from the application, progress and final report documents for 25 projects using 45 and Up Study data from January 2011 until December 2017, we a) determined the proportion of projects that intended to have policy or practice impact and b) described the type of policy and practice impact achieved.

Results: We found that 88% (n = 22) of projects intended to have a policy or practice impact. Of those, 68% (n = 15) planned to influence or inform a policy or program, and 41% (n = 9) planned to share findings at conferences or in journals. Almost half of projects with intended impact (45%, n = 10) did not state how they planned to achieve impact. Approximately 16% of all projects (n = 4) reported achieving an impact on policy or services. The type of impact achieved by all four of these projects was influencing, informing or changing a policy or program. One of these four projects also achieved a change to legislation or regulation.

Conclusions: Further strategies to promote a targeted approach to impact planning in research projects using datasets such as the 45 and Up Study would help guide researchers in achieving impact.

Lung cancer causes nearly 2 million deaths per year worldwide, and cases continue to rise. Most lung cancer is diagnosed at late, incurable stages, and the five-year survival is a fraction of that for other common cancers, including breast, prostate, melanoma and colorectal cancer. Lung cancer screening (LCS) in high-risk populations using low-dose computed tomography (LDCT) could potentially save thousands of lives per year by shifting the stage at diagnosis to early curable disease. Although an LCS program has not yet started in Australia, two trials have provided local data on the feasibility, selection criteria and outcomes. A government-commissioned report has detailed a potential national program, and Federal Budget funding has been committed to early feasibility projects that include population-specific consultations with, for example, Aboriginal and Torres Strait Islander communities who are at higher risk of lung cancer due to high smoking rates. Effective recruitment to LCS, embedded smoking cessation and the provision of subsequent lung cancer care to all at-risk Australians remain key priorities for any future LCS program.

Objectives: In response to the coronavirus 2019 (COVID-19) pandemic, a research project was developed with a cohort of 45 and Up Study participants to generate timely, relevant evidence to guide policy, practice and planning. This paper describes the research model, the cohort establishment and characteristics, and some findings.

Methods: A subgroup of 45 and Up Study participants was invited to enrol in 45 and Up COVID Insights -a series of five online surveys conducted during 2020-22. The model involved a close collaborative partnership with the New South Wales Ministry of Health and a panel of scientific advisers, an agile data collection methodology and rapid dissemination of findings. Frequent, iterative engagement with stakeholders provided a framework for identifying survey themes and questions and ensured wide dissemination of findings. Themes included healthcare use, attitudes toward and uptake of COVID-19 prevention measures, and the impact of the pandemic on mental health, loneliness, and lifestyle behaviours.

Results: 45 and Up COVID Insights achieved strong stakeholder engagement through extensive consultation and rapid reporting of results. The project recruited a diverse cohort of 32 115 participants: median age 68 years (range: 56-100+); 8% from outer regional/remote areas; 12% from the most socioeconomically disadvantaged communities; and 9% from culturally and linguistically diverse backgrounds. The first four surveys found that the impact of the pandemic varied across populations and stages of the pandemic. Between February-April (survey 2) 2021, 10% reported missed healthcare in the past month because of the pandemic, rising to 26% by September-November 2021 (survey 4). Quality of life remained high (>90% good-excellent across the surveys). As the pandemic progressed, the proportion reporting worsened mental health as a result increased from 29% (July-December 2020, survey 1) to 46% (survey 4). In survey 2 (February-April 2021), 89% intended to get the COVID-19 vaccine, with 8% unsure. By late 2021, vaccination uptake was high, with 98% of respondents having received at least one vaccination.

Conclusion: There is great value in harnessing a large longitudinal, well-described, and diverse cohort study to generate evidence in a changing context with evolving information needs. The collaborative model enhanced the value and relevance of the data to inform decisions.

Background/objective: To describe the attributes that have underscored the success of the 45 and Up Study (the Study) and demonstrate its value by reflecting on two case studies: our research on socioeconomic inequalities in cardiovascular disease; and the harms of smoking. Type of program or service: The Study is the largest study of healthy ageing in Australia, and one of the biggest in the world; it recruited 267 357 participants aged 45 years and older from NSW, Australia from 2005 to 2009. For more than 15 years, it has provided high-quality evidence on a broad range of public health related issues. We reflect on its value using two research case studies.

Results: Four key attributes have enabled the success of the Study: its establishment as a collaborative resource, including early and ongoing engagement with researchers and policy and practice partners; its large scale, which makes it ideally suited to quantify associations between risk factors and health outcomes, including for high priority populations; high quality self-reported survey data; and linkage to routinely collected administrative data, including specialised data. Novel Australian findings on cardiovascular disease (CVD) and smoking illustrate how the Study has contributed to national and international evidence, informing policy and practice. Results on CVD demonstrated individual-level education-related inequalities in CVD incidence and mortality, and greater use of pharmacotherapy for secondary prevention of CVD, in people with low versus high socioeconomic status. In terms of smoking, Study data showed that current smokers have around three times the mortality of never-smokers; that even "light" smoking of <14 cigarettes per day doubles mortality; that quitting is beneficial at any age; that smoking increases the risk of multiple cancer types; and that smoking causes half of deaths in Aboriginal and Torres Strait Islander adults aged 45 years and over and more than one-third of all deaths in the population. This evidence has been used by more than 50 government and non-government organisations, including contributing to legislation, policy and national and international monitoring and reporting.

Lessons learnt: The Study has fulfilled a vital role in public health research and practice in Australia, providing locally relevant data to enable research on health issues of importance, including health inequity. Through ongoing partnerships, the Study's data has contributed to international scientific evidence and been used to inform public health policy and practice. It has also been used as a focus for collaboration and capacity building.

Objective: To summarise and comment upon research regarding the service delivery impact of the introduction of COVID-19 pandemic Medicare Benefits Schedule (MBS) psychiatrist telehealth services in Australia in 2020-2021. Type of program or service: Privately-billed, MBS-reimbursed, face-to-face and telehealth consultations with a specialist psychiatrist during the first year of the COVID-19 pandemic.

Methods: This paper draws on analyses of previously published papers. MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April-September 2020 in Victoria, and compared to face-to-face consultations in the same period of 2019 and for all of Australia. We also extracted MBS-item-consultation data for all of Australia from April 2020-April 2021, and compared this to face-to-face consultations for April 2018-April 2019.

Results: Although face-to-face consultations with psychiatrists waned following nationwide lockdowns, the introduction of MBS billing items for video and telephone telehealth meant that overall consultations were 13% higher in April 2020-April 2021, compared to the pre-pandemic year prior. A lockdown restricted to Victoria was associated with a 19% increase in consultations from April-September 2020, compared to the corresponding period in 2019.

Lessons learnt: Telehealth has been an integral component of Australia's relatively successful mental health response to COVID-19. The public availability of MBS data makes it possible to accurately assess change in psychiatric practice. The Australian Federal Government subsidises MBS telepsychiatry care by a patient rebate per consultation, illustrating that government-subsidised services can rapidly provide additional care. Rapid and substantial provision of telepsychiatry in Australia indicates that it may be a useful substitute or adjunct to face-to-face care during future pandemics and natural disasters.